A fully funded, full-time 2 year postdoctoral position in
political philosophy at the Universitat Pompeu Fabra, Barcelona, in the context of an
ERC Consolidator Grant (648610) project led by Serena Olsaretti on “Justice and the
Family: An Analysis of the Normative Significance of Procreation and Parenthood in a
Promises and Challenges in Patient- and Family-Centered Care
Patient- and family-centered care (PFCC) promotes respect for patients and families, information sharing, shared decision making and care planning, and collaborative service delivery. It is one part of a movement towards participatory medicine that values patients’ and family members’ knowledge and experience, an outgrowth of the shift in recent decades toward prioritizing patient autonomy. When and how is striving to deliver inclusive care ethically complex? How should medicine accommodate families alongside patients, and what ethical challenges arise when trying to do so? With feedback and contributions from patients and family members, this theme issue of the AMA Journal of Ethics considers some of the ethical challenges of implementing PFCC.
The position is part of a broader project on early intervention in child moral development, in which there are 5 studies. One of the studies, on which this postdoc will primarily be working, will focus on prenatal intervention; the research will include work with mums who are part of the Family-Nurse Partnership programme in the UK and Ireland, and with scientific teams looking at the genetics and epigenetics of aggression and anti-social behaviour.
The person should be in post in Oxford by January 2016. I’m hoping to find someone who is conceptually and methodologically strong and innovative, with a background in anthropology, bioethics, sociology, health geography, or the like. Willingness to think out-of-the-box and an interdisciplinary orientation are important.
Ethics of Family network member Janice McLaughlin recently did a Radio Interview discussing some of her research on family. The podcast is available here is from Radio 4’s Thinking Allowed series, 1st of April 2015. The interview focused on a recent paper in Sociological Review titled ‘Family ties in genes and stories: The importance of value and recognition in the narratives people tell of family’.
The paper discusses the experiences of families who have a child referred to a genetics clinic due to developmental issues that remain undiagnosed. The genetic exploration can involve taking family histories and it is this opening up of family pasts the paper explored and is discussed in the Radio 4 interview. The research was funded by the ESRC and the full team were Emma Clavering, Michael Wright and Erica Haimes. The project, including a report for families and practitioners, can be found here: http://www.ncl.ac.uk/peals/research/project/2745
Preconception carrier testing: Medicalization or enhancing autonomy?
Marian Verkerk, PhD (Professor Ethics of Care at the University of Groningen, University Medical Centre Groningen)
Ulrik Kihlbom, PhD (Senior Lecturer in Medical Ethics at Uppsala University)
Julia Inthorn, PhD (Researcher at Universitätsmedizin Göttingen)
Preconception carrier testing (PCT) typically takes place in the context of reproductive healthcare, where results may be used to inform prospective parents of their options regarding family planning.(1)
Currently a first pilot on PCT is being developed and implemented at the University Medical Centre Groningen. The test provides couples, planning a pregnancy, with information, whether one or both partners are carriers of an autosomal recessive inherited diseases. (3),(4). One can distinguish different sorts of preconception carrier testing: cascade, targeted and population based testing.(2) The pilot developed in Groningen is a form of population based testing. Population based testing differs from other forms of preconception testing in that it is offered to persons not known to have an indication for testing based on either symptoms, family history or the outcome of prior pregnancies.
The diseases tested for are rare so in most cases there is no known family history of the disease. Carriers of such diseases are not affected and asymptomatic. Couples where both partners are carriers have different options when it comes to family planning. They can decide to live with the risk and choose not to do anything. Options to avoid the risk range from non-medical options like refraining from having children, adopting children or even changing partner, to the use of reproductive technologies like IVF and pre-implantation diagnostics, prenatal diagnostics or sperm/egg donation.
In June 2014 the Minister of Health in the Netherlands stated that she does not at this stage implement population based testing as part of a governmental supported
screening program. Private initiatives such as in Groningen are allowed under certain conditions. Her reluctance to implement population based screening programs are based on the fear of medicalization of pregnancy and the risk that prospective parents will be confronted with uncertain information that will cause insecurity or that it will give them the false idea that – after a negative outcome – they will have a healthy child.(5).
The argumentation of the Minister is surprising as it is in contrast with what seems to be the widespread bioethical view on the main aim of PCT: enhancement of reproductive autonomy, by enlarging reproductive choices for would be parents. In that it is strictly distinguished from screening or testing that is introduced for non- reproductive reasons, such as aiming at providing opportunities for treatment or prevention. According this view the danger for medicalization and the diminishing of reproductive autonomy because of the awareness of uncertain risks are misplaced(2).
In this contribution we will argue for a more nuanced ethical discussion of PCT. A strict distinction between the two goals –enhancing autonomy versus prevention and other public health values – cannot be maintained according to us. Even if we would say that PCT is all about enhancing reproductive autonomy, this must still be qualified as focused on decision making with regard to (serious) health problems in prospective children. In other words any kind of implementation is always embedded in a medical context of risk information and some sort of ‘medical indication’. Secondly, we will plea for a concept of reproductive autonomy in which reproductive choices are made in a moral landscape of what is normatively expected from prospective parents, especially in contexts where reproductive practices such as PCT may become routinized. This moral landscape consists of normative expectations about prospective parental responsibility and responsible parenthood (genetic accountability for pregnancies) (1). For a debate of a possible population based implementation of PCT these, often implicit, assumptions about what is normatively expected when it comes to ‘healthy pregnancy’ need to be unpacked and deconstructed. Arguments against PCT such as the risk of medicalization and diminishing reproductive autonomy can only be sufficiently countered when those hidden assumptions about responsible reproductive choices are explored and elaborated.
1. McGowan ML, Cho D, Sharp RR. The Changing Landscape of Carrier Screening: Expanding Technology and Options? Health Matrix J Law-Med. 2013 Spring;23(1):15– 33.
2. De Wert GMWR, Dondorp WJ, Knoppers BM. Preconception care and genetic risk: ethical issues. J Community Genet. 2012 Jul;3(3):221–8.
3. Kingsmore S. Comprehensive Carrier Screening and Molecular Diagnostic Testing for Recessive Childhood Diseases. PLoS Curr. 2012 May 2;4:e4f9877ab8ffa9.
4. Bell CJ, Dinwiddie DL, Miller NA, Hateley SL, Ganusova EE, Mudge J, et al. Carrier Testing for Severe Childhood Recessive Diseases by Next-Generation Sequencing. Sci Transl Med. 2011 Jan 12;3(65):65ra4–65ra4.
5. Ministerie van Volksgezondheid W en S. Kamerbrief over screening rondom zwangerschap en geboorte – Kamerstuk – Rijksoverheid.nl [Internet]. 2014 [cited 2014 Jul 24]. Available from: http://www.rijksoverheid.nl/documenten-en- publicaties/kamerstukken/2014/06/04/kamerbrief-over-programmatisch-aanbod- van-preconceptionele-dragerschapsscreening-en-nipt.html
Call for abstracts: “Beyond the nuclear family: the philosophy of close personal relationships” (10-11 September 2015, Umeå University)
Target: Graduate students and recent PhDs.
We invite submissions for papers to be presented at the conference “Beyond the nuclear family: the philosophy of close personal relationships”, funded by the Riksbankens Jubileumfond – The Swedish Foundation for Humanities and Social Science. The conference addresses normative questions concerning close personal relationships and the family, such as: the relationship between family values and family structures, the value of the family and caring relationships, the prospect of the marriage-free state, procreative liberty and procreative responsibility.
Speakers: David Archard (Queen’s University), Elizabeth Brake (Arizona State University), Clare Chambers (University of Cambridge), Daniela Cutas (Umeå/Gothenburg), Anca Gheaus (Umeå/Sheffield), Kalle Grill (Umeå University), Mianna Lotz (Macquarie University), Bonnie Steinbock (University of Albany), Anna Smajdor (University of East Anglia) and Adam Swift (University of Warwick).